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Explore challenges & strategies in preventing influenza in primary care settings, including vaccination promotion & waste management guidelines for healthcare professionals.
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Infection Prevention and Control and it’s challenges in the Primary Care Setting! Brenda O Sullivan Connolly. 2016 Presentation
Presentation Outline Topics covered in the presentation are based on requests for information identified on the closed Practice Nurse Face Book Page
What is influenza (also called flu)? • Influenza is an acute contagious respiratory illness caused by infection with an influenza virus. Influenza can occur throughout the year but activity usually peaks in winter. • Influenza viruses infect the nose, throat and lungs. They can cause mild to severe illness and at times can lead to death. The best way to prevent flu is by getting the flu vaccine each year. • Influenza is a serious public health problem that causes severe illnesses and deaths for higher risk populations.
Three types; A, B and C ( A and B-human illness occur more frequently) • Acute self limiting illness, upper or lower RTI lasts 2-7 days. • Sudden/ Acute onset of symptoms. • Pyrexia >38◦c, cough, headache, severe malaise, sore throat, sore muscles/joints, SOB. • Can be severe in >65yrs, those with underlying medical conditions
How is it spread? • Coughing, sneezing, contaminated hands or surfaces. • Anyone with flu can be infectious from 1 day before to 3-5 days after onset of symptoms. • Highly infectious and can survive on worktops/ objects. • Virus can live on hard surfaces for up to 24hrs and soft surfaces for 20mins
In the Practice What can you do ??? • Standards precautions- Every patient, Every time • Hand hygiene. WHO 5 moments. • Clean equipment between patients. • Assess on arrival, Act fast for suspected patients • Contact & Droplet. • ? Diagnostic sample viral swab. • Review, assess, plan, evaluate
Vaccination Encourage vaccination for high risk groups. Flu Vaccination- Encourage your colleagues – including the GP. Flu Vaccination is highly recommended for all Health Care Workers. Mandatory in some countries/states.!
Influenza Vaccine Staff Uptake in Hospitals, 2015-2016 (n=50 Hospitals) (HPSC 2016) Participation 50 hospitals provided sufficient data for complete analysis Uptake (average) Among all HCWs was 22.5% highest among ‘medical and dental’ professionals lowest among ‘nursing’ staff Acute Paediatric Services Hospital group highest uptake: 37.6% In general uptake higher in larger (staff numbers) hospitals 7 (14.0%) hospitals reported uptake > 40% among all HCWs (HSE Target)
Influenza Vaccine Staff Uptake in LTCFs, 2015-2016 (n=98 LTCFs • Participation • 101 out of 229 (44.1%) of known LTCFs participated • Uptake (average) • LTCF HCWs was 26.6% • highest among ‘medical and dental’ professionals • lowest among ‘nursing’ staff • 18 (18.4%) LTCFs exceeded 40% national uptake target • Range across Community Health Organisations: 15.2-48.1% • highest in CHO 9 (Dublin North, Dublin North Central, Dublin North West) at 48.1%
Uptake by Health Care Workers (HCWs) in Hospitals* by Season
Waste Management in healthcare settings • Department of Health and HSE (2014) Healthcare Risk Waste Management, Segregation, packaging and storage guidelines for Health Care Risk Waste, 5th edition (November 2014)
Definitions • Healthcare Risk Waste • Infectious Waste • Healthcare Non-Risk Waste.
Healthcare Risk Waste • This is categorised as risk waste which is potentially hazardous to those who come in contact with it by nature of its infectious, biological, chemical, radioactive nature or because it contains used sharp material which could cause injury.
Infectious Waste • Infectious substances are defined as substances containing viable micro-organisms or their toxins which are known to cause disease.
Healthcare Non-Risk Waste. • Non risk waste which is not hazardous to those who come in contact with it. Its contents are non-infectious, non-radioactive or residual chemical waste
Non Risk Waste Bag - Domestic Waste Not contaminated with blood orhazardous body fluids-Plastic, gloves, aprons, gowns, masks – INCLUDING from isolation cases Nappies/incontinence wear, stoma bags –from non-infectious patients.
Non Risk Waste Bag - Domestic Waste • Oxygen Face Mask and Tubing • Empty Urine Drainage bags and Urinary Catheters • Enteric feeding Bags • Giving Sets with Tips Removed. • Clear Tubing e.g.- NG etc
Non Risk Waste Bag - Domestic Waste • Normal commercial and catering waste • Non infectious, non-toxic, non-radioactive • Shredded waste documents of a confidential nature.
Health Care Risk Waste: Yellow Bag Yellow Bags • All soiled bandages, Swabs, gown, gloves, tissues and soft disposables. • Gloves, gowns, Aprons, Mask contaminated with blood or infectious body fluid. • Incontinence pads and nappies from known or suspected enteric infections (e.g. Rotavirus etc) • Suction Catheters, tubing and wound drains.
Health Care Risk Waste: Yellow Bag • No free fluids. • No sharp items. • No chemical or pharmaceutical waste
Used for sharps with the exception of cytotoxic waste Syringes Scalpels Contaminated slides Stitch cutters Razors. Sharps Bin
Sharps Bin with Purple lid • All needles, syringes, sharp instruments, cartridges + broken glass that have been used in the administration or production of cytotoxic/cytostatic medicines or other toxic pharmaceutical waste.
Recognisable large anatomical body parts, placentas. Waste containing blood or tissue that may have originated from a patient with known or suspected TSE/CJD. Contaminated large metal objects. Yellow Rigid Box with Black Lid
NON sharp healthcare waste contaminated with cytotoxic/cytostatic medicines or other toxic pharmaceutical waste, discarded chemicals and medicines. Small quantities of medication left over after administration to patient – e.g. glass antibiotic vials. Yellow Rigid Box with Purple Lid
Storage and other considerations • Healthcare risk waste must be treated with the respect it deserves. • It contains potentially dangerous material so therefore • Must be handled carefully. • Never dragged along the floor. • Never thrown!! • Must be stored separate to non risk waste
Cleaning of Equipment • Equipment used in health care may be designated as ↑ single use, single patient use or reusable multi-patient use – always read the label if you are not sure if an item can be reused • Any equipment not designated as a single use item must be made safe following use to prevent micro-organisms being transferred from equipment to patients and potentially resulting in infection. • Cleaning is the critical element of the process and should always be undertaken thoroughly regardless of the level of decontamination required.
Decontamination of Equipment. All items that are used between patients must be cleaned between patients. Devise a cleaning list to ensure that all equipment is also cleaned weekly.
Decontamination of Equipment. • Most equipment requires cleaning only with detergent and water. • Disinfection with a hypo chloride is required in the following circumstances • Contaminated with blood or body fluid – e.g. ACTICHLOR PLUS 1.7g in 100mls of water is the disinfectant of choice in this circumstance as per blood /body fluid spillage policy • After contact with a patient who has a condition known or suspected of being transmitted by contact. ACTICHLOR PLUS 1.7g in 1000mls of water
Decontamination of Equipment. • Decontamination is a process (or combination of processes), which removes or destroys contamination and thereby prevents micro-organisms or other contaminants reaching a susceptible site in sufficient quantities to cause infection or other harmful response. • It is important to establish the differences between cleaning, disinfection and sterilisation, which are used in the process of decontamination.
Decontamination of Equipment • Cleaning The physical removal of contaminants including dust, soil and organic matter, along with a large proportion of micro organisms. Thorough drying following cleaning will cause a further reduction. This is the first and most important step in any decontamination process. • Disinfection Utilising heat or chemicals to reduce the number of viable micro- organisms to a level which is not harmful to health (but not all viruses and/or bacterial spores) • Sterilisation Renders the object free from viable micro-organisms, including bacterial spores and viruses
Low Risk: Items in contact with healthy skin or mucous membranes or not in contact with patient Medium Risk: Items in contact with intact skin, particularly after use on infected patients or prior to use on Immuno-compromised patients, or items in contact with mucous membranes or body fluids High Risk: Items in close contact with a break in the skin or mucous membrane or introduced into a sterile body area. . Cleaning Disinfection Disinfection or sterilisation Process is categorised as one of 3 levels
Sterilisation • For Sterilisation using bench top steam sterilisers • Wear appropriate PPE • Items must be physically clean before being exposed to any sterilisation process
Additional general good practice points • The decontamination process chosen must be effective for the device being reprocessed • Cleaning can be undertaken by either manual or automated methods • Ensure decontamination agents used are compatible with the devices and the reprocessing equipment • Decontaminate devices in accordance with the manufacturer’s instructions • Ensure appropriate decontamination facilities are available for the process to be undertaken
Additional general good practice points • Ensure any decontamination equipment used is fit for purpose, regularly maintained, validated and tested • Staff undertaking decontamination activities should be trained for the tasks they undertake • Standard infection control precautions should be adhered to at all times • Workflow should proceed from dirty to clean • Sterile and sterilised devices must be segregated and stored in clean dry conditions, out of the decontamination area.
MRSA MRSA- identify high risk patients and encourage screening if scheduled for surgical procedure- may need to be decolonised pre-op.
Patients deemed high risk for MRSA should be considered for preadmission screening & decolonisation particularly if for planned surgery BSH offers a preadmission screening clinic for all patients undergoing orthopaedic implants & other surgeries It is available to all high risk patients Cost of €120: covers initial screening, decolonisation treatment and follow up screening Please contact the IPCN's at 021 4801619 if your patients would like to avail of this service Patients from Kerry can be facilitated in BSH Tralee by contacting the IPCN's in Cork
MRSA Screening Both nostrils (1 swab) Perineum Wounds, sites of damaged or abnormal skin (leg ulcers) and sputum if expectorating Medical device sites e.g. insertion sites of intravenous catheters, drains, peg tubes, catheter urine samples. Throat, both axilla and groins in KNOWN MRSA colonised patients and those who give a history of MRSA All previously positive sites if still existent.
